Teaching quality improvement in a primary care residency

Several organizations emphasize that medical education should include how to improve patient outcomes effectively using quality improvement (QI) methods. In spite of the importance of teaching QI principles, limited literature exists on the implementation and evaluation of these in residency programs.

The Clinical Scholars Program was established in 1996 to provide residents an opportunity to participate in a scholarly activity. The program, fully integrated into a community-based, university-affiliated family medicine residency program, is currently structured as a longitudinal educational experience, with specific time lines in which all second- and third-year residents are required to participate in and successfully complete a project before graduation. Factors influencing project success are also presented.

During the five-year period evaluated, 61 residents completed 53 Scholars projects, 39.6% of which were QI projects. Residents have delivered 86 local presentations, 50 state presentations, 11 national presentations, and 8 international presentations. Nine resident projects have been published in peer-reviewed journals. Factors associated with successful interventions include focus on a topic relevant and common in primary care practice, change in the system of patient care (for example, use of group visits, providing patient education directly to the patient prior to his or her visit), use of the electronic medical record to provide relevant clinical information during office visits, and interdisciplinary team participation in the project.

This program is an example of the successful integration of scholarly activity and QI education into a residency program. It serves as a potential model for other residency programs to meet the needs of residency training and to promote QI and research in primary care practices.